Deb's Blog

In the helping professions, it’s far too easy to stretch yourself thin. We all got into this work because we wanted to support those in need and to make the world a better place. There is abundant opportunity to make a difference—because there is no shortage of suffering, sadness, pain and loss. But no one can do this work for long before learning, sometimes the hard way (read “burnout”), that we all have physical and emotional limits that must be respected, or we can’t do our best for those we seek to serve.

Setting professional and personal boundaries as an Aging Life Care™ Manager does not mean shirking responsibilities or being insensitive to clients’ needs. It does mean recognizing the importance of self-care as the foundation of being fully present for others. This holds true for all caregivers, whether a family member, friend or career professional.

Setting Realistic Boundaries Is Essential to Well-Being

Given that the overwhelming majority of professionals in this field (and caregivers, in general) are women—and that women are socialized in our culture to put the needs of others before our own—learning to set realistic boundaries can be difficult. It may even feel physically uncomfortable to say no when the default is to say yes to a plea for help.

But boundaries are essential to maintaining personal wellbeing and integrity. Especially when we find ourselves overwhelmed by a rash of client crises, severe illnesses or deaths, we need to be vigilant in finding ways to replenish emotional resources. The alternative is physical and mental exhaustion that can lead to poor judgment, sickness, accidents or worse.

Here are five ways to set realistic professional boundaries and foster your personal wellbeing:

Manage client expectations about your availability. Be clear about your professional hours and availability in your contract and conversations. Consider whether you can realistically offer 24/7 response, especially if you are a one-person practice. Sleep matters. So does your emotional well-being.

Give yourself permission to not answer the phone during off hours. There are many ways to screen calls, from voice mail to professional answering services. Pick the method that suits your personal style and budget, and hold to it. The vast majority of those calls can wait until morning. The ones that can’t, you’ll undoubtedly be able to anticipate.

Think carefully about how big a caseload you really need to maintain. As the Baby Boom generation ages, there is plenty of work to go around. The real question we all need to ask ourselves is how much we can actually take on. Financial goals provide part of the answer. Professional career goals need to be accounted for, as well. Ultimately, however, it comes down to how to balance the ability to provide quality service with maintaining physical and mental health, as well as fostering quality relationships with our own loved ones.

Carve out time for activities that replenish you—and stick to it. Exercise, walks in the woods, films with a friend, date night with your significant other, a good novel, even that trashy TV show you love watching—whatever healthful activity works for you, discover it, claim it and do it. Regularly. The time you spend feeding your soul will not only give you a much needed break; it will recharge your batteries and enable you to be all the more effective in your personal and professional relationships.

Seek joy and laughter. Even in the midst of struggle and hardship, there is much to celebrate in life. Our clients teach us these lessons every day. Stay open to the possibilities.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

Caring for an aging loved one can wear you down. Worry about pain and suffering, power struggles, physical strain, emotional stress, financial fears, anxiety over what the future holds—the list goes on. In troubled times, when you are pulled in multiple directions by all of your responsibilities, the effort to keep your head above water can seem herculean.

But traumatic times can also trigger emotional growth. The ability to cultivate resilience is an essential skill for wellbeing, especially when the future seems dark.

Recognize Common Stressors

The most common stressors that challenge our resilience are familiar to anyone involved in caregiving. Sirois identifies the following:

Presence of chronic suffering;

Lack of time;

Lack of power;

Not enough support, a sense of isolation;

Stressful patients; stressful family members;

Confusing or shifting rules, power structures and relationships.

Seek Opportunities for Growth

But stress and uncertainty also bring opportunities for creative problem solving and new approaches. Sirois describes these as the “Five Domains of Post-Traumatic Growth”:

The opening of new possibilities not present before;

A change (deepening) in relationships with others;

An increased sense of one’s own personal strength;

A greater appreciation for life in general;

A deepening or significant change in ones’ spirituality.

Practice Healthful Ways to Adapt to Change

People who practice resilience have learned healthful ways to adapt to change while under stress. Close, dependable relationships provide key emotional support. Knowing your limitations, when and how to ask for help—and receive it—is also essential. Savoring the moment, practicing gratitude, leading from your strengths and perseverance are all qualities to cultivate.

Easier said than done when you’re under pressure. We all stumble and get stuck. Remember that this is a mindful mindset that takes constant practice. Sirois cites Karen Reivich, author of The Resilience Factor, who offers four questions to ask yourself on the path to “grounded optimism.” Next time you find yourself sinking under stress, complete these sentences:

A more accurate way of seeing this is . . .

One possible other explanation is . . .

My thoughts aren’t necessarily true because (list evidence) . . .

A more likely outcome is . . .

Your answers may well surprise you. Opening up to new possibilities takes a willingness to question and consider alternative ways of seeing the world. Each new step you take will undoubtedly stir up fear and anxiety that accompany any change. But clarity of vision and positive action also generate new energy and strength.

Stay mindful, celebrate your successes and give yourself room to falter. Cultivating resilience, like cultivating a garden, takes time, persistence, patience, a willingness to get your hands dirty and the reward of a creating a space of beauty, peace and renewal.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

Your 85-year-old father has Parkinson’s and loses his balance, falling and breaking his hip. Or your 79-year-old mother has congestive heart disease and is hospitalized for shortness of breath. Fill in the blank for the precipitating event: when your aging loved one lands in the hospital for an extended stay, he or she will need help.

The Long Road to Recovery

For all the wonders of modern medicine, getting appropriate care in a hospital is not guaranteed. Even in the best hospitals, many factors contribute to elderly patients’ risk of decline during their stay. Uncomfortable diagnostic testing, repeated blood draws and vital signs checks, noise, light, a rotating cast of health care professionals visiting at times that are convenient to their schedules, rather than the patient’s—not to mention the persistent risk of infection and complications following surgery or other medical procedures—all add up to sleep deprivation, confusion and stress when the patient is already in pain or a weakened state.

Delirium—the rapid onset of confusion and reduced awareness of physical environment—caused by illness, medication side effects, disorientation from lack of sleep, and unfamiliar surroundings, poses a significant risk for patients over 65, Another risk is malnutrition in patients who refuse to eat while in the hospital. The rush to discharge patients as soon as possible, prompted by Medicare and private insurance reimbursement rules, can result in complications from inadequate follow-up care. Even with a solid discharge plan, elderly patients take longer to recover from hospitalization—about one week for every day spent in the hospital.

Improving Chances of a Good Outcome

Here are some ways to help your loved one have a better chance of a successful outcome from a hospital stay:

Whenever possible, make sure that a responsible family member or friend is with your loved one. The doctor’s arrival is never predictable, and it’s essential that someone who can understand the medical issues and treatment options is present, both to advocate for your loved one and to help him make any decisions. An Aging Life Care Manager™ can be a key member of this team effort.

Understand that your loved one’s primary care doctor is usually not in charge. Even if the physician has hospital privileges, there is a special team of hospitalists who oversee patient care on the floors. When you or your loved one has questions, ask for the doctor managing the case and request to speak to her personally. Nothing will replace the trust established in a long-term doctor-patient relationship, but quality communication with the hospitalist is essential for informed decision-making.

To protect your loved one’s privacy, conduct any conversations about her in a private space—not the hallway or in front of a roommate’s family or other visitors.

Keep a notebook by the bed, with names and pager numbers of all essential members of your loved one’s medical team. Take notes when the doctor visits. Keep track of test results.

Bring your loved one’s advanced planning documents and have them scanned into his record. There is no need to fill out new forms if this work has been done in advance and represents your loved one’s current wishes.

Collaborate with your loved one’s hospital case manager and/or social worker to provide accurate, timely information that will enable them to create a realistic, workable discharge plan. Include your Aging Life Care Manager™ in the discussion.

If your loved one is able to return home, recognize that she has a new baseline. Make sure she is comfortable and has necessary support during the day during her transition back to health. If she is confused, have a family member or reliable help stay overnight until the confusion clears.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

Gun ownership is not only one of the most politically sensitive topics this election season. It’s also a question that is frequently asked when Aging Life Care Managers™ conduct an assessment of a new client. Unsecured firearms, sometimes combined with a variety of diagnoses, are a safety concern of many professionals.

This past July, the Aging Life Care Association™ (ALCA) surveyed members to find out how many include questions about firearms when interviewing prospective clients, and, if so, how that affected their providing services in the home.

ALCA does not take a position on guns or gun ownership. As a professional society, their purpose is to provide education, networking and professional development to their members.

Firearms Ownership an Important Factor in Home Assessments

Fully 50 percent of those surveyed (141 of 282) said they include a question in their assessment regarding the presence of firearms. Some respondents said it was their employer’s requirement to ask this question; others said knowledge of firearms in the home was as important as knowing about the client’s driving ability, medications, alcohol or tobacco use, or potential sources of elder abuse. Many commented that they have not asked the question in the past, but will in the future. In addition,

52 percent require that firearms are securely locked up;

10 percent require that firearms be removed;

1 percent decline to provide services if firearms are present.

Safety Risks Depend on Individual Circumstances

Further findings show:

The majority of Aging Life Care Professionals™ found the frequency of guns in the house “Very Rarely” (31.2 percent) or “Sometimes” (27.2 percent).

The biggest threats to firearm safety in the home included diagnoses of dementia, depression, PTSD or mental illness of any kind.

Most respondents said if there are firearms in the house, they require that guns are securely locked up (52 percent).

A very few (less than 1 percent) felt it was not appropriate to ask clients about gun ownership.

Overwhelmingly, respondents said they had to evaluate the safety implications of guns in the house on a case-by-case basis, citing cognitive functioning, medications, diagnoses, family dynamics, etc.

Certain Diagnoses May Increase Suicide Risks If Firearms Are Present

Several respondents recounted stories of suicides by clients that took place while professional caregivers were in the home. Said one, “I had a client commit suicide after the family said all firearms were removed from the house. He had one hidden. He was terminal with brain cancer with metastasis.” A similar circumstance was described by another care manager as “one of the worst days of my life.”

Conversations about gun ownership can also open new doors in a client-care manager relationship. Said one care manager, “Discussing firearms, hunting stories and war stories involving the use of firearms is a great way to bond with your client.”

As the survey found, certain diagnoses can result in a dangerous environment both for the client and those working in the home. And even with professional supervision, mistakes can be made. One respondent described this case:

“Client 92, former military. Family felt guns were out of the house. Professional guardian (former military herself) conducted detailed search of the home after appointed and assured me that there were no weapons in home. The client threatened to shoot the night caregiver but never produced a gun. However, while filling medication boxes and securing extra meds in a lockbox in a spare room, I found a handgun. Now I always assume there could be a weapon even if I am told there is not one.”

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

For many adult children, the idea of placing your aging parent in a nursing home can feel like a failure:

“That’s where old people go to die.”

“You should take care of your mother like she took care of you.”

“No one wants to end up in a nursing home. It’s so impersonal.”

Frankly, many Aging Life Care Professionals™ also struggle with these same feelings.

While it’s true that we’d all prefer to remain independent, in our own homes, for as long as possible, instead of living in an—admittedly—institutional care setting, the reality is that for some people, a move to a nursing home can be the best thing that could have happened.

Listen to the words of the late Clara Epstein, who wrote this about her move to a Worcester, Mass., nursing home in 2005:

Four years ago my husband became a resident here at the Jewish Healthcare Center after overcoming serious heart surgery. He lived here for 2.5 years, completely relaxed, becoming a person most loved by staff. They took care of him until the moment he died. Today is my 100th day here. I am like a new person. Ninety-two years old is only a number to me. I truly enjoy the care and the activities . . .

Advantages of Nursing Home Care

There comes a point in the progression of age and disease when the advantages of living in a skilled nursing facility—round the clock nursing care; physician on site; the ability to receive medical support without going to the Emergency Room; assistance with dressing, bathing, personal hygiene and eating; physical therapy; a wide range of social activities; safety and security—can actually be a boost.

Here are some of the factors that contribute to a nursing home move. Absent the ability, for whatever reason, to provide 24-hour home care, these are issues that often make nursing home care an essential move that can actually enhance overall health and well-being:

Incontinence;

Fall risks;

Advancing Alzheimer’s and other forms of dementia;

Severe physical pain;

Emotional isolation;

Safety and security risks;

Frequent trips to the Emergency Room;

Primary caregiver(s) unable to continue in that role;

Limited public options in the community (depending on state of residence) and limited financial resources to pay privately for home care.

Valuing Needs of the Individual

Modern nursing homes place a high priority on the needs of the individual, allowing for personal tastes in waking and sleeping, when and what to eat, access to favorite music, participation in activities and more. Someone who has been living alone, with little if any company, immersed in anxiety and depression about life, can brighten significantly when surrounded by caring professionals.

Some individuals also thrive when their lives are simplified; that might mean being in a different setting. For family members whose lives have been consumed by serving as nurse, case manage and caregiver, appropriate nursing home placement can also mean a much needed respite and a return to other important family roles.

Choosing a nursing home, if that is the right step, takes careful research and consideration. An Aging Life Care Professional™ can help you and your loved one sort out the best options for appropriate placement and timing.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.